WebMail, upload, or email this form to the Medicare contractor that services your geographical area. An EFT authorization form must be submitted for each Medicare contractor to whom you submit claims for Medicare payment. To locate the mailing address for your Medicare Administrative Contractor fee-for-service contractor, go to: WebPlease give us a call or fill out the form below. We are passionate about our business and want to help any way we can. Corporate Headquarters Palmetto GBA 17 Technology Circle Columbia, SC 29203 Give Us a Call (803) 735-1034 Are you a small business interested in partnering? Register for our Small Business Database. Register

Provider Authorization Form - CGS Medicare

WebMar 30, 2024 · Online ERN (ERA) / Report Restore Form; Provider Address Job Aid; Provider Enrollment Applications; Reason Code Help Tool; Recovery Audit Contractor (RAC) ... The responsibility for the content of this file/product is with Palmetto GBA or CMS and no endorsement by the AMA is intended or implied. ... Provider Contact Center: 855 … WebThe purpose of the J15 EDI Application Form is to enroll providers, software vendors, clearinghouses and billing services as electronic submitters and recipients of electronic claims data. It is important that instructions are followed and that all … fviss ise list

Help Desk - Palmetto GBA

WebPalmetto GBA has dedicated representatives available to provide technical assistance and answer questions about the eServices portal. Be prepared to provide the following information when you call: Provider name Your name, email address and telephone number PTAN NPI Tax ID Line of business (Medicare Parts A, B, Railroad, etc.) WebOption Direct Data Entry (DDE) is an online computer inquiry system that provides easy and immediate access to claims processing and beneficiary eligibility information for … Webwhen submitting the EDI Enrollment Agreement or Provider Authorization Form. A Submitter ID number is a unique number identifying electronic submitters. A Submitter ID can be used to transmit Part A, Part B and HHH EDI transactions to Palmetto GBA. You must request a Submitter ID if you will be submitting claims directly to Palmetto GBA. gladius mini troubleshooting